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Skeletal survey, chest CT, and referral to an orthopaedic oncologist for biopsy
1%
114/8021
Open reduction and internal fixation
112/8021
Hip abduction brace immobilization with the hip in 45 degrees of flexion and neutral rotation for 6 weeks
2%
180/8021
Protected weight bearing and activity as tolerated
92%
7393/8021
Immobilize in 120 degrees of knee flexion for 24 hours followed by physical therapy
157/8021
Select Answer to see Preferred Response
The clinical presentation and radiograph is consistent with a right sided iliac crest avulsion. Treatment includes protected weight bearing and activity limitations until asymptomatic. Avulsion fractures are commonly seen in adolescent athletes and can include the sartorius, tensor fascia lata, gluteus medius, and the abdominal muscles. The most common sites of apophyseal fractures are the ASIS (origin of sartorius), ischium (origin of hamstrings), lesser trochanter (iliopsoas), AIIS (rectus femoris) and iliac crest (abdominal muscles). Rossi et al. performed a Level 4 study of pelvic apophyseal fractures. They reported 203 avulsion fractures over a period of 22 years. The ischial tuberosity was involved in approximately 50% of the cases followed by the AIIS(25%), anterior superior iliac spine (ASIS)(20%), superior corner of pubic symphysis(4%) and iliac crest (1%). Figure A demonstrates a right iliac crest apophyseal fracture. Incorrect Responses: Answer 1,2,3,5: None of these treatments would be appropriate in an iliac crest avulsion fracture.
3.7
(20)
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